On raising a son on the autism spectrum, progressive politics, pop culture, and coffee addiction.

Tuesday, January 05, 2010

Always be eating

We are the champions, my friends.

Bud had a great visit with his pediatrician today. I've been in high-anxiety mode since late summer, when, as the result of a much-needed switch in the timing of his medication, Bud's appetite kicked into overdrive and he gained 11 pounds in three months. Shortly after that, the news was full of reports that this sort of rapid weight gain was not atypical for children on this type of medication. Typical or not, though, it was dangerous for Bud and his doctor warned that it could cause him to develop diabetes. At that point, Bud's diet got an overhaul.

And it worked. As of today, Bud is back to the height/weight ratio he had in the summer and his BMI is within the normal range. Of course, we need to stay focused and stay on course, but today it's feeling really good.

I'm loathe to give advice on this sort of thing, because I suspect it's a "your mileage may vary" kind of issue, but I also imagine that there are lots of parents out there Googling things like "autism medication weight gain solutions" as frantically as I was a few months ago. And maybe something that worked for us will spark an idea for somebody else. So...

First, the most significant turning point in my thinking about Bud and food came when his doctor explained to me what the medication was doing in Bud's brain. Up to that point, I thought that the medication had simply increased Bud's appetite, and that the solution lay in finding foods that would fill him up and stay with him without adding too many calories to his diet. So, I focused on foods that were high in fiber, but it seemed that no matter how much he ate, he never felt full.

The reason, his doctor explained, is that the issue was not really one of hunger. A side effect of his medication is that it basically deactivates the trigger in his brain that tells him when he is full. So, even when his body is satisfied - indeed, even when it is OVER-filled - Bud will still feel hunger.

Suddenly, I understood why my boy was eating a pound of bananas in a single day.

I asked the doctor what other parents had done to combat this. She said that, in honesty, those that had been most successful had gone the route of using locks - locks on the cupboards; locks on the refrigerator.

I pictured my kitchen as a fortress. I imagined how it would feel to Bud. I imagined how confusing it would be to my dad, who is already struggling enough with confusion. And then I dismissed the idea.

Instead, I focused on devising a plan that would let Bud feel like he was eating all the time. I reasoned that, since he would feel the same level of hunger no matter what he ate, the important part was to make him feel like he was always able to have something.

And so evolved Operation Always Be Eating:

- I used the Weight Watchers approach to choosing foods, trying to find low fat/high fiber substitutes for the foods Bud liked (Fiber One pancakes instead of Aunt Jemimah, fat free American cheese instead of regular - that sort of thing).

- I made sure there were some things that would keep his mouth busy that he could always help himself to - sugar-free Popsicles and sugar-free gum were ALWAYS available in large quantity.

- I stopped buying fruit juices and started buying single-serving bottles of water, which are just more fun for a kid to drink than a glass of water from the tap.

- I bought sugar-free juice packets to mix in to the bottled water, and while I'd prefer that he had less artificial sugar in his diet, sometimes you just have to choose the lesser of the evils.

- I found low cal, low fat treats he liked and didn't keep any high-fat, high-cal treats in the house. The biggest score? Cool Whip Free. Almost no calories, and he feels like he's eating ice cream.

- I learned that portion control is a key to success. As long as Bud was having the same KINDS of foods, he didn't make a fuss about the quantity. One piece of toast was just as good as two. A small banana was as good as a big one. Using smaller plates and bowls helped to make it SEEM like he was having just as much as ever. 100-calorie snack packs were valuable because they had built-in portion control AND had the added benefit of not leaving an open bag of something that would be easy to steal from. I also did a lot of splitting 100-calorie packs (creating two 50-cal pretzel bags or three 33 1/3 cal mini-muffin treats.)

- I learned that if Bud needed to feel like he could always be eating, I had to rethink the "three meals a day" approach to food. So, breakfast became the thing that happens over the course of the morning. Lunch became the thing that happens over the course of mid-day. Items that would once have been presented together as a total lunch "package" were metered out instead, piece by piece, hour by hour.

- I also learned that some things need to stay as they are. His weekend cheese pizza from the local pizza shop? The thing he loves more than anything else? It stays the same, in frequency, size, and drippy, greasy content.

And so far, so good - or, so says the doctor's scale. I have to say, in some ways, the autism-driven preference for sameness works to our advantage. Now, when given a choice, he will choose to buy the Weight Watchers ice cream treats instead of the higher-calorie (better tasting) versions. Because he likes what he knows, and now, that's what he knows.

Bud has also been a trooper about it. We've talked a lot about healthy eating. He's working at it. He's still stealing food now and then, but not to the same degree. He's becoming a partner in the process - and I have to think that the medication he's on - the one that's causing the problem to begin with - has also been instrumental in helping him regulate enough to be more thoughtful about his food intake.

It's still a daily concern and I still have to monitor it closely. But for today, it feels like a victory - and I'm going to eat it up.

9 comments:

THANK YOU!!! We have our appointment with our wonderful Pediatrician in two weeks and I KNOW she would have said the same things about locks. My ds had his med increased a few months ago and he has packed on the pounds quickly. He is very active so I can't just increase his activity more but I can't get him to stop eating. I don't want to live in a house with locks on everything but I don't want him to become obese either. Thanks for posting what you learned and tried. It gives me so many avenues to try and most of all - hope!

Charlie stopped taking the med (I think we're talking about the same med) in June of 2009 and we saw a gradual but definite decrease in his obsessive need to eat. I think you are right-on about the effect of said med, as far as it makes one not know that one is full. Often Charlie just seemed to eat and eat, beyond when he was full, and then sometimes I suspect he felt sick (to his stomach, literally) and there were "behaviors." He only eats now as much he needs to and has less trouble with his stomach.

I really think doctors don't always fully take into account how difficult it is to deal with the "side-effects" of these medications!

I also much liked your aside (re the Weight Watchers frozen treats) about using Bud's tendency to prefer the same thing to advantage. Charlie is quite hooked on only eating one type of vanilla soy ice cream and he refuses most other types (all that Ben & Jerry's.....); he's disappointed when the store is out of the soy stuff, but handles it ok.

With the risperdal my eldest packed on the pounds, but except for the lovely sugar withdraw when he came off of it, his weight has gone back down to 'normal'. He'll never be skinny - genetically impossible in this family - but he's fine now. The first few times he went to the Ped's after it was gone his height had gone up and weight had stayed the say... I was very pleased. Karate helps.

The little one packed the pounds on this fall after he started the risperdal (0.25mL/2x's daily) - but he was skinny before so had room to put a few on. I never thought about it, but I too have been handing out food during the day instead of at a sitting. He's slimming down again (went from a size 8 to 10 - height since Sept - did size 6 to 8 last winter - 4") but he's the one that's going to be over 6' tall, compared to his bro's maybe 5'8". He's taller than the elder who's 2yrs older (8 and 10yrs). So I have to be careful that with this growing, he's not hungry from that as well. Swimming, walking, toboganning etc helps.

One of my "resolutions" is to switch up my cooking. Including the chicken broth/veggies and rice soup I made a couple of nights ago. Trying to keep the calories down.

I am so glad to read about yours and Bud's success! I'm especially glad to read that you used a really sensible approach and didn't go the lock route! Whew.

My husband and I often lament the fact that none of the doctors that prescribe medications, be they risperdal or augmentin, have to live with the side effects and the behaviors that result from the altered brain patters or the painful side-effects. In a perfect world, they would have to take our children for a week to experience what we do. I bet we'd be amazed at the rise in helpful suggestions for how to actually deal with them. LOL

You could not have written this post at a better time! This is just what has been on my mind A LOT lately. We are noticing this so much with Andrew lately. He his now a pants size bigger than his older brother. I have a script to get blood work to check for diabetes and I am putting it off because I dread it, but know I need to check. He's gaining and he's sneaking food so much, but like you said, the benefit of the medication has been so great for Andrew. I know that it is making the world of difference in his life, but the health thing is a great concern of mine. I am going to print out this post and devise our own plan. I think it will help that his mother will be going to weight watchers. Hopefully! Thanks for writing this!!!!!!!

A-freakin-men. Jaysen packed on the poundage with "the med". His sensory aversions to most foods make it near impossible to change his diet (although I'm still trying!), and he was put on another med to counteract the weight gain. Just what we wanted. Another med. So happy Bud was able to flex enough for this awesome success!

...Instead, I focused on devising a plan that would let Bud feel like he was eating all the time. I reasoned that, since he would feel the same level of hunger no matter what he ate, the important part was to make him feel like he was always able to have something.

My son is on the same med (I think) and he did gain a bit of weight, which was normal. I took a similar approach, better quality of foods. More protein/fiber to help him fill up and not bulk up. I didn't want him to feel shame about eating (Lord knows we all struggled with that!) so I filled the house with good things.